At a Glance
Summary: A Bronx County court permitted defendants to conduct supplemental depositions and follow-up discovery concerning civil actions involving the plaintiffs’ medical providers, even though the court refused to allow fraud-based defenses and a counterclaim.
Rule: A RICO complaint does not prove fraud by a personal-injury plaintiff. But where the allegations bear on the plaintiff’s treatment or knowledge, they may support targeted discovery.
Claims Adjuster Consideration: Treat provider-related RICO allegations as an investigative lead—not a reason automatically to reduce the claim. Determine whether the provider, treatment, referrals, or allegations actually connect to the damages being claimed.
Litigation Impact: The emerging First Department rule favors narrow, case-specific discovery over broad accusations of fraud.
Court: Supreme Court, Bronx County
Justice: Hon. Erin Noelle Guven, A.J.S.C.
Decision Date: September 11, 2026
Case: Gonzalez Carvajal v. Roadrunner Equipment Leasing LLC, Index No. 816378/2023E
Topic: RICO Discovery | Medical Providers | Fraud | Personal Injury | Claims Investigation
Introduction
A plaintiff’s treating provider turns up in a civil RICO case.
What should the claims handler or the attorney defending the case do next?
Do not assume fraud. But do not ignore the information either.
A recent Bronx County decision adds to a developing First Department line that provides a useful middle ground.
In Gonzalez Carvajal v. Roadrunner Equipment Leasing LLC, the court allowed defendants to reopen discovery concerning civil actions involving the plaintiffs’ medical providers. At the same time, it continued to reject their attempt to plead fraud-based affirmative defenses and a counterclaim.
That distinction is important:
A RICO allegation may justify an investigation and discovery without establishing fraud.
For claims professionals, the question is whether the information changes the evaluation of treatment, damages, settlement value, or reserves.
For defense counsel, the question is whether the information can be converted into focused, permissible discovery.
What Happened
The plaintiffs alleged serious injuries arising from a February 7, 2023 motor-vehicle accident.
The defendants previously sought leave to amend their answer to assert fraud-related defenses and to obtain additional discovery concerning alleged fraud. The court denied that motion.
On reargument under CPLR 2221(d), the defendants emphasized a narrower point: even if they could not plead fraud, they should be permitted to investigate civil RICO actions involving some of the plaintiffs’ medical providers.
Specifically, the defendants sought discovery concerning whether the plaintiffs knew that treatment they received may have been exaggerated or unnecessary.
That argument succeeded.
The Court’s Decision: Discovery Yes, Fraud No
The court permitted supplemental depositions of the plaintiffs and appropriate post-deposition discovery demands. But the discovery was limited.
The defendants could inquire into what the plaintiffs knew, if anything, about the facts underlying the civil actions involving their providers and whether they were aware that any medical treatment may have been exaggerated or unnecessary.
The court did not, however, revive the defendants’ fraud theories.
Among the problems was reliance. Alleging that the plaintiffs intended defendants or insurers to rely on representations is not the same as adequately alleging that defendants actually relied upon them. The court also noted the tension between claiming reliance and having denied the plaintiffs’ allegations throughout the litigation.
That creates two separate questions:
Is there enough information to investigate?
and
Are there enough facts to plead fraud?
The answer does not have to be the same.
A Developing First Department Rule
Gonzalez Carvajal is not an isolated decision.
In Franco v. 800 E 173 LLC, 240 AD3d 446 (1st Dept 2025), the First Department upheld a further deposition based on civil RICO actions involving the plaintiff’s attorney and medical providers. The defense could inquire about the accident, the scope of treatment, and whether the plaintiff knew that treatment may have been exaggerated or unnecessary.
Then, in Santacruz v. 58 Gerry St LLC, 246 AD3d 600 (1st Dept 2026), the Court rejected fraud claims based on unproven RICO allegations but nevertheless allowed a further deposition and targeted post-deposition discovery—without removing the case from the trial calendar.
And in Arita v. FDS Associates, LLC, the First Department again rejected proposed fraud defenses while permitting limited discovery into what the plaintiff knew about the RICO allegations involving his attorneys and medical providers.
The line is becoming fairly clear:
Unproven allegations do not establish fraud by the plaintiff. But a sufficiently connected RICO case may justify targeted discovery into the plaintiff’s treatment and knowledge.
From a Claims Perspective
Suppose surgery is driving a substantial damages demand and a treating provider appears in a civil RICO case.
The wrong reaction is:
“The doctor is accused of fraud, so the claim is worth less.”
The better questions are:
- Did this provider actually treat this claimant?
- What treatment or surgery did the provider perform?
- How important is that treatment to the damages claim?
- Who referred the claimant to the provider?
- Do the allegations in the outside case concern the same type of treatment?
- Does the claimant’s testimony match the medical records?
- Are there unusual referral, lien, financing, or treatment patterns?
- Would additional testimony or documents materially affect the damages evaluation?
Only then can the information become useful for claims evaluation.
That investigation may affect the medical review, IME strategy, expert selection, mediation position, settlement authority, or reserve.
Or it may establish that there is no meaningful connection at all.
Both are useful outcomes.
For Trial Counsel: Build the Factual Bridge
For litigators, the decisions suggest that how the request is framed matters. A generalized request to investigate “fraud” invites resistance.
A stronger application connects the requested discovery to the plaintiff’s actual damages claim:
This plaintiff seeks substantial damages based upon treatment rendered by this provider. The defense seeks narrowly tailored discovery concerning how the plaintiff came to the provider, what the plaintiff was told about the need for treatment, what treatment the plaintiff understood was being performed, and whether the plaintiff possessed information bearing upon whether that treatment was exaggerated or unnecessary.
That is a discovery argument. It does not require the court first to find fraud.
The First Department’s decision in Lituma v. Liberty Coca-Cola Beverages LLC reinforces the importance of the factual bridge. There, the defense submitted an affidavit detailing links among the plaintiffs, medical providers, and participants in other allegedly suspicious accidents. The showing supported additional discovery because the defense explained why the information was material to the case.
Specifc facts beat generalize suspicion.
Do Not Overreach on Fraud
The First Department continues to draw a harder line when defendants try to convert outside RICO allegations into a fraud defense.
In Rijo v. YYY 62nd St. LLC, 248 AD3d 600 (1st Dept 2026), the Court rejected a proposed fraud defense resting on conclusory allegations and unrelated RICO litigation. The defendants also failed adequately to plead justifiable reliance.
But the Court added an important qualification: nothing prevented the defendants from pursuing issues concerning allegedly disproportionate medical treatment to challenge credibility and damages. New York Courts
That is an important litigation distinction:
Losing the fraud defense does not necessarily mean losing the damages investigation.
Claims and Litigation Strategy
When credible provider information surfaces, I would approach the file in this order:
- Verify the source. Obtain the actual complaint, decisions, and underlying court materials—not merely an article or database hit.
- Connect it to the claimant. Identify the provider, treatment dates, procedures, referrals, bills, liens, and claimed future care.
- Review existing testimony. Determine what the plaintiff has already said about treatment recommendations, referrals, surgery, and financing.
- Develop targeted discovery. Ask for the testimony and documents that address the actual gaps rather than demanding generalized “fraud discovery.”
- Reevaluate exposure after the investigation. Determine whether the information changes damages, expert strategy, mediation posture, settlement authority, or reserves.
For the adjuster, that produces better information for valuing the file.
For the attorney, it creates a better record for obtaining the discovery.
Discoverability Is Not Trial Admissibility
One final caution: discoverable does not necessarily mean admissible.
A pending fraud or RICO lawsuit involving a treating physician may justify investigation while still being excluded from the jury.
That distinction is discussed in my Physician Impeachment Evidence in New York Injury Cases analysis. New York courts distinguish unresolved accusations against physicians from proven credibility evidence such as certain convictions. New York Civil Law
Do not skip directly from allegation to trial strategy.
Practical Impact
The useful lesson from Gonzalez Carvajal is not simply that defendants obtained another deposition.
It is the distinction the court drew.
A RICO complaint is an allegation.
It may provide a legitimate reason to investigate.
What the investigation actually proves is another question.
For the claims professional:
Does this information change the evaluation of the claim?
For defense counsel:
Can I connect the information to the treatment and damages sufficiently to obtain useful discovery?
For both:
Are we addressing the issue early enough to make a difference?
Do not turn an allegation into a conclusion. Turn it into an investigation. Then determine whether the investigation changes the case
Forward This Post
If this analysis affects a claim file, coverage position, or motion strategy, forward it to the person handling the issue.
Read more analysis from New York Civil Law here.
Questions This Decision Answers
- Can a RICO case involving a plaintiff’s doctor support additional discovery in New York? Yes, in an appropriate case. Franco, Santacruz, Arita, and now Gonzalez Carvajal support targeted discovery where the information bears on the plaintiff’s treatment or knowledge.
- Does a RICO complaint against a medical provider establish fraud by the plaintiff in a New York personal injury lawsuit? No. Unproven allegations against attorneys or providers do not, without more, establish fraud by the individual plaintiff. New York Courts
- Can another deposition be taken after the note of issue in New York litigation? Potentially. Santacruz authorized further RICO-related deposition discovery without vacating the note of issue. New York Courts
- Must the defense successfully plead fraud before obtaining this discovery in a New York litigation? No. Arita, Santacruz, and Gonzalez Carvajal illustrate that the discovery issue and the fraud-pleading issue are separate.
- Can treatment still be attacked if a fraud defense fails in a New York personal injury lawsuit? Yes. Rijo specifically recognized that defendants remained free to pursue issues concerning allegedly disproportionate treatment to challenge credibility and damages.
Related New York Civil Law Analysis
For the next stage of the analysis, see Physician Impeachment Evidence in New York Injury Cases, addressing when provider-related information may actually reach the jury. New York Civil Law
For discovery involving financial relationships and the importance of building a case-specific factual connection, see New York Litigation Funding Discovery After Perdomo and Lituma
Sources
Gonzalez Carvajal v. Roadrunner Equipment Leasing LLC, Index No. 816378/2023E, NYSCEF Doc. No. 133 (Sup. Ct., Bronx County Sept. 11, 2026).
Franco v. 800 E 173 LLC, 240 AD3d 446 (1st Dept 2025) — Official Decision
Santacruz v. 58 Gerry St LLC, 246 AD3d 600 (1st Dept 2026) — Official Decision
Arita v. FDS Associates, LLC, 2026 NY Slip Op 01152 — Official Decision
Rijo v. YYY 62nd St. LLC, 248 AD3d 600 (1st Dept 2026) — Official Decision
Lituma v Liberty Coca-Cola Beverages LLC, 243 AD3d 504 (1st Dept 2025)
Photo Credit: Hush Naidoo Jade